The Incidence of Catheter Tract Hemorrhage and Catheter Placement Accuracy in the CLEAR III Trial

for the CLEAR investigators

Research output: Contribution to journalArticle

Abstract

Background: Incidence of catheter tract hemorrhage (CTH) after initial ventriculostomy placement ranges from 10 to 34%. We investigated CTH incidence in the Clot Lysis: Evaluation of Accelerated Resolution of Intraventricular Hemorrhage Phase III trial. Methods: Prospective observational analysis of 1000 computer tomography (CT) scans from all 500 patients enrolled in the trial. All catheters were evaluated on first CT post-placement and on last CT prior to randomization for placement location and CTH size, location, and severity. Clinical variables were assessed for association with CTH with multivariable logistic regression. Results: Of 563 catheters, CTH was detected in 14 and 21% of patients on first and last CT (median 3.7 and 43.4 h after catheter placement, respectively). All, but one were asymptomatic. Majority of CTH (86%) occurred within 24 h after placement, were located within 1 cm of the skull, and had at least one diameter > 5 mm. Most catheters (71%) terminated in the third or lateral ventricle ipsilateral to insertion site. Factors significantly associated with CTH were pre-admission use of antiplatelet drugs, accuracy of catheter placement, non-operating room catheter placement, Asian race, and intraventricular hemorrhage expansion. Conclusions: CTH incidence on initial catheter placement and during stabilization was relatively low, despite emergent placement in a high-risk population. Catheter placement accuracy was similar or better than convenience samples from the published literature. Decreasing risk of CTH may be achieved with attention to catheter placement accuracy and placement in the operating room. Antiplatelet agent use was an independent risk factor for CTH.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalNeurocritical Care
DOIs
StateAccepted/In press - Jan 2 2018

Fingerprint

Catheters
Hemorrhage
Incidence
Tomography
Platelet Aggregation Inhibitors
Ventriculostomy
Third Ventricle
Lateral Ventricles
Operating Rooms
Random Allocation
Skull
Logistic Models

Keywords

  • Catheter tract hemorrhage
  • Computed tomography
  • External ventricular drain
  • Intracerebral hemorrhage
  • Intraventricular fibrinolysis
  • Intraventricular hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

The Incidence of Catheter Tract Hemorrhage and Catheter Placement Accuracy in the CLEAR III Trial. / for the CLEAR investigators.

In: Neurocritical Care, 02.01.2018, p. 1-10.

Research output: Contribution to journalArticle

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title = "The Incidence of Catheter Tract Hemorrhage and Catheter Placement Accuracy in the CLEAR III Trial",
abstract = "Background: Incidence of catheter tract hemorrhage (CTH) after initial ventriculostomy placement ranges from 10 to 34{\%}. We investigated CTH incidence in the Clot Lysis: Evaluation of Accelerated Resolution of Intraventricular Hemorrhage Phase III trial. Methods: Prospective observational analysis of 1000 computer tomography (CT) scans from all 500 patients enrolled in the trial. All catheters were evaluated on first CT post-placement and on last CT prior to randomization for placement location and CTH size, location, and severity. Clinical variables were assessed for association with CTH with multivariable logistic regression. Results: Of 563 catheters, CTH was detected in 14 and 21{\%} of patients on first and last CT (median 3.7 and 43.4 h after catheter placement, respectively). All, but one were asymptomatic. Majority of CTH (86{\%}) occurred within 24 h after placement, were located within 1 cm of the skull, and had at least one diameter > 5 mm. Most catheters (71{\%}) terminated in the third or lateral ventricle ipsilateral to insertion site. Factors significantly associated with CTH were pre-admission use of antiplatelet drugs, accuracy of catheter placement, non-operating room catheter placement, Asian race, and intraventricular hemorrhage expansion. Conclusions: CTH incidence on initial catheter placement and during stabilization was relatively low, despite emergent placement in a high-risk population. Catheter placement accuracy was similar or better than convenience samples from the published literature. Decreasing risk of CTH may be achieved with attention to catheter placement accuracy and placement in the operating room. Antiplatelet agent use was an independent risk factor for CTH.",
keywords = "Catheter tract hemorrhage, Computed tomography, External ventricular drain, Intracerebral hemorrhage, Intraventricular fibrinolysis, Intraventricular hemorrhage",
author = "{for the CLEAR investigators} and Achim M{\"u}ller and Mould, {W. Andrew} and Freeman, {W. David} and Nichol McBee and Karen Lane and Rachel Dlugash and Richard Thompson and Saman Nekoovaght-Tak and Vikram Madan and Hasan Ali and Agnieszka Stadnik and Issam Awad and Hanley, {Daniel F} and Ziai, {Wendy C}",
year = "2018",
month = "1",
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doi = "10.1007/s12028-017-0492-6",
language = "English (US)",
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T1 - The Incidence of Catheter Tract Hemorrhage and Catheter Placement Accuracy in the CLEAR III Trial

AU - for the CLEAR investigators

AU - Müller, Achim

AU - Mould, W. Andrew

AU - Freeman, W. David

AU - McBee, Nichol

AU - Lane, Karen

AU - Dlugash, Rachel

AU - Thompson, Richard

AU - Nekoovaght-Tak, Saman

AU - Madan, Vikram

AU - Ali, Hasan

AU - Stadnik, Agnieszka

AU - Awad, Issam

AU - Hanley, Daniel F

AU - Ziai, Wendy C

PY - 2018/1/2

Y1 - 2018/1/2

N2 - Background: Incidence of catheter tract hemorrhage (CTH) after initial ventriculostomy placement ranges from 10 to 34%. We investigated CTH incidence in the Clot Lysis: Evaluation of Accelerated Resolution of Intraventricular Hemorrhage Phase III trial. Methods: Prospective observational analysis of 1000 computer tomography (CT) scans from all 500 patients enrolled in the trial. All catheters were evaluated on first CT post-placement and on last CT prior to randomization for placement location and CTH size, location, and severity. Clinical variables were assessed for association with CTH with multivariable logistic regression. Results: Of 563 catheters, CTH was detected in 14 and 21% of patients on first and last CT (median 3.7 and 43.4 h after catheter placement, respectively). All, but one were asymptomatic. Majority of CTH (86%) occurred within 24 h after placement, were located within 1 cm of the skull, and had at least one diameter > 5 mm. Most catheters (71%) terminated in the third or lateral ventricle ipsilateral to insertion site. Factors significantly associated with CTH were pre-admission use of antiplatelet drugs, accuracy of catheter placement, non-operating room catheter placement, Asian race, and intraventricular hemorrhage expansion. Conclusions: CTH incidence on initial catheter placement and during stabilization was relatively low, despite emergent placement in a high-risk population. Catheter placement accuracy was similar or better than convenience samples from the published literature. Decreasing risk of CTH may be achieved with attention to catheter placement accuracy and placement in the operating room. Antiplatelet agent use was an independent risk factor for CTH.

AB - Background: Incidence of catheter tract hemorrhage (CTH) after initial ventriculostomy placement ranges from 10 to 34%. We investigated CTH incidence in the Clot Lysis: Evaluation of Accelerated Resolution of Intraventricular Hemorrhage Phase III trial. Methods: Prospective observational analysis of 1000 computer tomography (CT) scans from all 500 patients enrolled in the trial. All catheters were evaluated on first CT post-placement and on last CT prior to randomization for placement location and CTH size, location, and severity. Clinical variables were assessed for association with CTH with multivariable logistic regression. Results: Of 563 catheters, CTH was detected in 14 and 21% of patients on first and last CT (median 3.7 and 43.4 h after catheter placement, respectively). All, but one were asymptomatic. Majority of CTH (86%) occurred within 24 h after placement, were located within 1 cm of the skull, and had at least one diameter > 5 mm. Most catheters (71%) terminated in the third or lateral ventricle ipsilateral to insertion site. Factors significantly associated with CTH were pre-admission use of antiplatelet drugs, accuracy of catheter placement, non-operating room catheter placement, Asian race, and intraventricular hemorrhage expansion. Conclusions: CTH incidence on initial catheter placement and during stabilization was relatively low, despite emergent placement in a high-risk population. Catheter placement accuracy was similar or better than convenience samples from the published literature. Decreasing risk of CTH may be achieved with attention to catheter placement accuracy and placement in the operating room. Antiplatelet agent use was an independent risk factor for CTH.

KW - Catheter tract hemorrhage

KW - Computed tomography

KW - External ventricular drain

KW - Intracerebral hemorrhage

KW - Intraventricular fibrinolysis

KW - Intraventricular hemorrhage

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